Provider Demographics
NPI:1639176332
Name:BER, LEON (DPM)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:
Last Name:BER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ROYALWOODS CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1774
Mailing Address - Country:US
Mailing Address - Phone:716-895-5454
Mailing Address - Fax:716-895-5454
Practice Address - Street 1:9 ROYALWOODS CT
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-1774
Practice Address - Country:US
Practice Address - Phone:716-895-5454
Practice Address - Fax:716-895-5454
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNO03066213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00687581Medicaid
T88399Medicare UPIN
NY082921Medicare ID - Type Unspecified